The effects on neurobehavior in 20 infants with prenatal exposure to cocaine, alcohol, marijuana, and cigarettes, compared to 17 infants exposed to alcohol and/or marijuana and cigarettes without cocaine and 20 drug-free infants, were assessed using the Neonatal Intensive Care Unit Network Neurobehavioral Scale at Brown University School of Medicine, Women and Infants Hospital, Providence, RI. Cocaine-exposed infants showed increased tone and motor activity, more jerky movements, startles, tremors, back arching, and signs of central nervous system and visual stress than unexposed infants. Visual and auditory following responses, and birth weight and length of cocaine-exposed infants were also reduced. 
COMMENT. Meconium testing was used to confirm lack of illicit drug use in the unexposed group. Positive meconium or urine assays were found in 5 women who had denied prenatal drug use. Urine toxicology can detect cocaine within 1 to 4 days of last use. Cocaine-exposed infants had neurobehavioral changes especially involving increased tone and motor activity. Synergistic effects of cocaine with alcohol and marijuana could not be ruled out.
Dose-related effects of cocaine on 3-week neurobehavior were demonstrated in a study at Children’s Hospital, Boston, MA. Comparing 38 heavily exposed infants, 73 lightly exposed, and 94 unexposed, after controlling for covariates, a significant dose effect was observed, heavily exposed infants showing poorer regulation of arousal and greater excitability at 3-week examination but not in the first few days of life. 
Since regulation of arousal and attention are important to learning, infants exposed to cocaine in utero may be expected to show decreased developmental scores and to have attention deficit disorders in childhood. (Ped Neur Briefs Feb 1996;10:9-10).